Canadian doctors warn against private medicine as a cure for systemic ills

With some 6.5 million Canadians lacking access to a personal doctor and endless wait times for some medical procedures becoming almost the norm, private health care is increasingly being touted as a solution to these and other problems in Canada’s health care system.

Private medicine comes in many forms. Ontario Conservative government plans to expand public funding cataract surgery and MRI scans in private clinics and order hip and knee replacement surgeries.

In Quebec, doctors are increasingly withdrawing from the public health system altogether to open private medical clinics, where patients pay thousands of dollars a year to see a family doctor. Elsewhere, clinics are exploiting a loophole in existing laws that prohibit paying for basic medical services by using nurses instead of doctors.

Canadians, impatient with wait times, have long been flying to other countries to take advantage of surgical procedures for which they pay themselves.

Many hospitals across the country are dealing with a nursing shortage that has become widespread during the pandemic by hiring fleeting nursing staff from for-profit agencies.

But now the design of the set recommendations of the Canadian Medical Association says it is time for governments to stop paying for services that have long been covered by the public health system and warns that private provision of health care can result in poorer quality care and higher costs.

“Whenever there’s a crisis in the system, there has to be change,” Dr. Joss Reimer, a Winnipeg physician who is president of the medical association, told me this week. “So I think this is a critical time for us to hear the voices of Canadians about what they want from this change, because there are gaps in the system. There’s no question that our public health system is suffering.”

The medical association made its recommendations after consulting with 10,000 healthcare professionals and patients, including through town hall meetings, surveys and focus groups.

Canada’s system has always been a mix of private and public services. Doctors themselves are not government employees, but they bill governments for their services, while covering the costs of their offices and employees. Many services, particularly lab tests, have long been provided by for-profit companies, which, again, charge governments for their services.

Dr. Reimer believes one of the main problems with turning to the private sector is that it inevitably worsens the shortage of doctors and nurses.

“When the proposed solutions are to fill the gaps with private services, it’s still the same health care providers who end up working in those private services,” Dr. Reimer said, noting that the Winnipeg hospital where she practices has closed some units due to a lack of nurses, “and yet we have nurses who are regularly transferring to nursing agencies.”

Although health care is a provincial responsibility, vast government transfers to the provinces to lend a hand them meet health care costs are subject to conditions set out in Canada Health Act. It prohibits doctors from charging for “medically necessary services” while also billing the provinces. However, only Ontario currently prohibits doctors from opting out of the public system.

ABOUT 780 doctors left the public system in Quebec, a province with a long waiting list for primary care physicians. By comparison, only 14 people have left the system in the rest of the country.

Dr. Reimer said the association also reviewed all available research on how patients fare when treated through publicly provided services, compared with patients treated by private providers. The overall trend, she said, was clear.

“Privately provided services, whether publicly or privately funded, tend to be more steep and have worse outcomes than the same service provided publicly,” she said. “When we looked at all the literature, that was certainly a trend that made us want to be very cautious about spending money on privately provided services.”

She said the trend does not mean that all privately provided healthcare is worse or more steep. However, she said governments will need to proceed with caution and look at any shifts towards private services from both a financial and medical perspective.

Private health care is, of course, a growing business in Canada. Last month, a pension fund in Ontario sold LifeLabs, one of the few vast laboratory testing companies to a vast American testing company for $1.35 billion Canadian.

In a report published in July report from the Ontario College of Pharmaciststhe province’s professional licensing body, warned that its members are facing increasing pressure from corporate dispensaries to augment business volume and profits.

These pressures impact “the quality of care they want to provide to their patients,” the report said.

He added that this situation means that “less attention is paid to the interests of patients and more to profit.”

Dr. Reimer acknowledged that the medical association’s recommendations to governments will face lobbying from corporations that want to “put a foot more into the health care system.”

She added: “I can’t say how those two different voices will weigh. But I do know that it is incredibly critical that doctors across the country and all the patients we speak to and represent have a voice.”

This section was written by Vjosa Isai, a Toronto-based reporter and researcher.

• Canadian ecologist David Suzuki has dismissed a risky idea proposed by scientist David Keith — cooling the Earth with pollution that blocks sunlight — as “arrogant and naive.”

• Elaine Glusac, a columnist for The Times’ Frugal Traveler, looks at how incentive programs are rewarding tourists for good behavior. In British Columbia, Tourism Squamish provides travelers with snack vouchers in exchange for bags of trash they pick up along trails and at campgrounds.

• The Times’ food editors tested coffee brands launched by celebrities including Tom Hanks, Emma Chamberlain and Toronto singer-songwriter The Weeknd, and the reviews were mixed.

• A U.S. Department of the Interior report has for the first time tallied the number of deaths of Indigenous children in public boarding schools.

• Canadian musician Alanis Morissette tells The Times about the moments in her life that give her strength and perspective, 25 years after the release of her second global album.

• Some exhibition featuring the work of Filipino-American artist Pacita Abad will be at the Art Gallery of Ontario this fall. “You’ll wish you had seen it,” wrote Andrew Russeth, art critic for The Times, in his review of Ms. Abad’s first retrospective at MoMA PS1 in Recent York.

• Best known for his opera productions, Canadian director Robert Carsen has taken his talents to Salzburg, Austria, where his version of “Jedermann,” an annual festival staple, “stands head and shoulders above other recent productions of the work,” writes The Times theater critic AJ Goldmann.

• Now, let’s get to the Olympics. Here’s a selection of stories involving Canadian athletes you might have missed this week:

  “Now we’re all experiencing the Olympics thanks to TikTok” (Times)

  Who is leading in the medal standings? (Times)

  Children at the Olympics: “It’s really crazy” (Times)

  Olympic espionage is just the latest example of the Canadian soccer team’s failure (Athletic)

  Canadian teen star Summer McIntosh sets Olympic record, winning gold in 200m butterfly (Athletic)

Born in Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa, and has covered Canada for The Recent York Times for two decades. Follow him on Bluesky at @ianausten.bsky.social.

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